Medical Assistance Renewal Request
Residents can request the following Department of Human Services forms with the online request form.
- Use this form if you receive SNAP, Housing Support (GRH), Medical Assistance with a spenddown, or MA-EPD.
- Do not use this form if experiencing unstable housing, age 65 or older with no income, people with disabilities and no income, traveling farmhands, or living on American Indian tribal lands.
Complete this form if you receive income from the Social Security Administration along with any of the following programs:
- SNAP
- Minnesota Supplemental Aid (MSA)
- Housing Support (GRH)
- Medical Assistance, including the Medicare Savings Program.
You can use this form to complete your yearly recertification if you are receiving SNAP and any cash program. If enrolled in Medical Assistance, including the Medicare Savings Program, a separate form is required.
This form is used for people enrolled in Medical Assistance, living in a skilled nursing facility, or receiving services through a community waiver.
This is the annual renewal form for Minnesota Health Care Programs for certain populations:
- 21 years of age or older with no dependents and have Medicare coverage
- 65 years of age or older
- A child currently in foster care
- Blind or have a certified disability
This is the annual renewal form for Minnesota Health Care Programs for families, children and adults.
This application is for anyone who is 65 years and older, is blind or disabled, enrolled in Medicare, receives Social Security income, or applying for MA-EPD.
Not currently active on Medical Assistance and may live in or looking to move into a nursing home or apply for community waiver services to remain in your home.
Currently active on Medical Assistance Program and may live in or looking to move into a nursing home or apply for community waiver services to remain in your home.